Applied Radiology

With 2300 of the world's top athletes competing at the highest level of competition on either ice or snow, it's a safe bet that injuries will occur and that prompt, professional medical attention will be necessary. To address these needs, the Olympic Organization, in conjunction with the University of Utah, created a freestanding clinic to provide multiple medical services for athletes, officials, and family members attending the XIX Olympic Winter Games in Salt Lake City. The facility, called the Polyclinic, will provide radiology, general sports medicine, dental, pharmacy, and laboratory services for the Winter Games and for the Paralympics immediately following.

Applied Radiology (AR) recently spoke with Julia Crim, MD, chief of musculoskeletal radiology at the University of Utah Hospitals and Clinics and chief of musculoskeletal imaging at the Polyclinic, and Mary Freeh, operations manager for the Polyclinic and director of radiology for the University of Utah.

AR: How long did it take to create the Polyclinic?

Julia Crim, MD: About a year. The University of Utah has what is called the "Guest House." The top floors of the building are rooms for people to stay in and the bottom floor was conference rooms. We designed the conference room area to be a clinic. We actually did a lot of construction, such as putting walls in, to turn it into a real hospital-certified clinic that meets all of the requirements for any U.S. facility. It is essentially a mini-hospital. It has been built beautifully. It's strange to realize that all this equipment has been installed and all this construction has been done and it will be disassembled at the end of March.

AR: What will happen to it?

JC: At the end of the Paralympics, on March 19, we start taking all the equipment back out, taking the construction apart, and turning the space back into the conference center. This has been one of the big parts of the University of Utah's donation to the clinic. They have had a full-time team working on nothing but this for about a year-- putting in a tremendous amount of time, money, caring, and professional expertise--all funded by the University. We have had no support from the Salt Lake Olympic Committee or the state of Utah.

AR: How is the radiology department of the clinic equipped?

JC: We have a donated magnetic resonance imaging system (1.5-Tesla mobile Signa Infinity system) from GE Medical Systems (Waukesha, WA), and an ultrasound unit (HDI 5000 SonoCT) from Philips Medical Systems (Bothell, WA). Eastman Kodak Health Imaging (Rochester, NY), the major medical imaging sponsor, donated a DirectView DR 9000 digital radiography system, Kodak DirectView DX diagnostic workstations, a Kodak PACS setup, and a paper printer. Talk Technology (Bensalem, PA) donated a TalkStationRadiology system to be used for voice recognition for our reports.

People have supported us with top-of-the-line new, beautiful equipment. I can't say how grateful we are. Kodak has essentially given us a full PACS system to be used just for the 2 months, and they have donated the personnel so that all of the visiting radiologists can be trained in how to use it and have the support they need. They trained all our personnel in how to use DR, since we have not used DR previously at the University.

AR: Is the entire system integrated?

JC: Yes. All three modalities (MRI, ultrasound, and DR) send images directly into the PACS archives, which then sends them directly out to the viewing station so that they can be read immediately. We also are able to send any or all of these images to the University hospital's archives in case a study needs to be looked at by a specialist at the hospital. Most of our radiologists at the Polyclinic are musculoskeletal specialists. Therefore, if we get, for example, a neurologic case, we may want to consult with someone in the University. We are also integrated with our radiology information system in the hospital for scheduling and patient identification functions.

Mary Freeh: There are two issues with regard to integration. One is that we were concerned that this is sensitive information, especially before the games; so there is very limited access to the information even though we are using the hospital system. Information access has been very carefully limited by our chief of information technology services to make sure that no one could call in and check on the other athletes. Even physicians at the hospital cannot do that; you have to have special clearance.

The other issue is that we wanted the athletes to be able to leave the clinic with a copy of their report and with relevant images. So, from the PACS, we print key images directly on the Kodak paper printer, which prints a high-quality image on glossy paper. When they leave, the athletes have the images and the report in an envelope that is theirs to take back to their home physician.

AR: How is the radiology department of the Polyclinic staffed?

JC: One of the things that I'm very excited about in the clinic is the team of radiologists that we have. I thought it would be fun to have a national team of radiologists, so I went to the Society of Skeletal Radiology and from my colleagues there, I chose radiologists from all around the country. There are 10 radiologists in total. We have two to three shifts a day with two to three radiologists overlapping. Almost all of the technologists are from the University of Utah. I was very pleased at how eager people were to volunteer, to take part, to give of their best. It is very exciting to have people from a variety of different institutions with a variety of different viewpoints working together in the setting of the Olympics.

AR: How many patients have you been seeing a day?

JC: It varies tremendously from day to day. Overall, we have seen more than 250 patients (by day 14 of the games) and many of those have had multiple exams. There have been approximately 3,000 clinic visits in total, but, obviously, a lot of those did not end up in radiology. We have performed about 350 exams, mostly on athletes, but some coaches as well.

I have been very pleased with how smoothly it is going. It was all a new--and temporary--setup, but it has worked very well. We've been doing everything as we planned: patients come in and leave with copies of their x-ray report and copies of their film.

AR: Have you had to use the PACS system to consult with the hospital?

JC: We had one head injury that required a consultation. Almost everything has either been musculoskeletal or abdominal imaging. We had one early pregnancy that required consultation as well.

AR: Has there been anything you haven't been able to do?

JC: No. It has worked great. We have seen most of the crashes that occurred on the hills, although in cases in which there was concern about the patient's safety, they have taken the patient directly to the emergency room instead. We have also been taking the computed tomography (CT) cases over to the hospital. We predicted that correctly; we needed the MRI much more than the CT. We've had to use CT in only three patients. We are also lucky that we have a top-notch ultrasonographer. He has been handling some of the non-musculoskeletal, as well as the musculoskeletal exams at a very high level, using the ultrasound as a CT.

AR: Is there anything else you would like to add?

JC: I would like to emphasize that the athletes have all been very nice. Sometimes it has been so busy that they have quite a bit of a wait, but they have been very easy to deal with. They have been very grateful to get the images and the reports to take back to their home country. The coaches have been a pleasure. The whole thing has been far more of a team than I had anticipated that we would be able to do with doctors from all over the country and all over the world and athletes from all over the world. It has worked very, very smoothly. AR